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The design of the healthcare environment is under attack again -- this time by a couple of academics that studied whether improving the patient experience has any impact on readmission rates.

In an article published last week in the Harvard Business Review online, Management Science Professors Claire Senot and Aravind Chandrasekaran assert that amenities such as health spas, stone fireplaces, and five-star restaurant chefs have little or no impact on the patient experience as measured by HCAHPS surveys. Instead, according to their research, what matters most is improving the communication between patients and caregivers.

Well, who could argue with that?

But, what bothers me is that they didn't acknowledge that the design of the physical environment could contribute to improving the patient experience. Or that better food and the availability of physical therapies (now recognized by the Joint Commission as effective for pain management) also might affect how patients felt about their stay in the hospital.

And what about the design of the physical environment's affect on people's ability to communicate with each other?

As Susan E. Mazer, Ph.D., points out in a whitepaper she wrote about the impact of The C.A.R.E. Channel on HCAHPS, "...in a noisy environment, the tenor of dialogue tends to rise in volume and be strained. Further, the ability for an elderly person to comprehend what is being said to them, even if the language is simplified, remains highly compromised in a chaotic and cluttered auditory environment."

Do a search for "communication" on The Center for Health Design's research repository, and you'll find several studies that found links between the design of the physical environment and the quality of communication between patients and staff.

Now, I'm not dismissing the importance or validity of Senot and Chandrasekaran's research.  In fact, it looks like a pretty good study.

But the reality is that everything impacts the patient experience. From the parking garage to the admissions clerk, room temperature, food, maintenance guy with the floor polisher, sounds and smells of the unit, and, of course, the doctor or nurse at the bedside.  And so much more.

Let's at least just acknowledge that, okay?

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Len Berry

9 years ago

Great post Sara. Patient experience is multi-dimensional. The dimensions play different roles in creating the experience.

John Zeisel

9 years ago

To a person with a hammer (replace with: "as measured by HCAHPS surveys") everything looks like a nail. The answer to their conclusions might lie in the "survey" they used.

Marjorie Serrano

9 years ago

On the first day of the move from 1950s Parkland Hospital to the new facility, we knew any challenges of the build & move were worth it because the patient rooms were so spacious & comfortable. After one month, the most impressive result is the dramatic increase in "teachable moments." The environment is quiet, private, & well-equipped providing the possibility of quality communication with patients & their families.


9 years ago

As a healthcare professional and a caregiver to my 89 year old Mother; the surveys sent out are not a true reflection of care given. Sending out a pt discharge survey is a waste of $$ but more importantly is not an accurate reflection of care. Talking to someone either face-to face or via telephone would give better data. Also so many patients are afraid to answer honestly for fear their care may be compromised; that is so sad.compassinate care is what continues to be lacking. I am my Mothers advocate/daughter NOT a visitor. Listen to families that really care for our patients. Remember empathy thank you

Joseph MacDonald

9 years ago

While 5-star chefs may be a bit much for a hospital, certainly nutritious and pleasing food matters. As for other amenities like fireplaces and views, they absolutely matter.

Jan Golembiewski

9 years ago

HCAHPS surveys are notoriously game-played. Healthcare organizations know the criteria, and how to get high results without having to genuinely change anything. This is always a problem with survey based data, but especially where millions of dollars rest on the results. I suspect the data in the HBR is flawed. Haven't read it though - but it would be a shame not to triangulate findings. Pitty HBR is so naive about the healthcare business!

Margaret Fleming

9 years ago

In my last inpatient experience, I got a few clues to this subject. My room had the best view in the L.A. area, a healing indeed, was pretty and clean. But it left me longing for designers to use a priority list system. My nightstand was where I couldn't reach it - leaving most of my urgent things spending time on the floor. I never saw a whirlpool, but I had one of the world's best physical therapists. (Never mind the others.)

A nurse told me that rooms around the corner, even smaller than mine, had always been in demand because the patients had a nature view. The hospital killed that by erecting a new section high enough to block their view.

The visitor chairs were too big for the narrow space, so I couldn't see a visitor's face. The priest just sat on the bed. Did the bed really have to be in the center, leaving no good aisle? Interior design is not just squares on the paper.

Allison Soeller

9 years ago

Excellent point. I'm an organizational communication PhD, my dissertation research was done in a hospital, and I couldn't agree with you more. Our physical environments are constructed and reconstructed socially through communication and interaction. The physical environment is part of this process as we draw on artifacts imbued with symbolic meaning. Design of space itself communicates meaning and values and these meanings and values are reinforced again and again by how the space (and the artifact in it) are used.

In Case You Missed Them: Top 10 Posts from 2015 - Sara Marberry Sara Marberry

8 years ago

[…] The design of the healthcare environment is under attack again — this time by a couple of academics that studied whether improving the patient experience has any impact on readmission rates. In an article published last week in the Harvard Business Review online, Management Science Professors Claire Senot and Aravind Chandrasekaran assert that amenities such as health spas, stone fireplaces, and five-star restaurant chefs have little or no impact on the patient experience as measured by HCAHPS surveys. More>> […]

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What's my story? I'm a healthcare and senior living design knowledge expert who writes and speaks frequently about trends and issues affecting these two industries. I'm also a strategic marketing consultant and content creator, working with companies and organizations who want to improve the quality of healthcare and senior living through the design of the physical environment. You can reach me at .

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